Prevention in Practice

Loyalty Card Schemes for Health Behavior Change: A Lesson in Business

The use of financial incentives has been advocated by both the UK and U.S. governments to encourage the adoption of healthy lifestyles. Although there is evidence to support the use of such incentives for changing some behaviors (e.g., smoking, substance abuse), for other health behaviors, for example physical activity, the evidence is sparse. Further, for such schemes to be implemented long term, they must be based on a sustainable model.

The concept of loyalty cards (or reward/points cards) may provide some interesting insights regarding long-term behavior change and sustainable business models that can be applied in public health.

A Lesson in Business

In the business sector, loyalty card schemes encourage repeated behavior (i.e., loyalty), such as shopping at a particular retailer, by rewarding customers for their repeated business by collecting points and subsequent rewards, for example, retail vouchers. This can be applied to the public health setting, for example, by participants earning points for minutes of physical activity, which are then reimbursed for rewards.

Loyalty Cards Versus Cash Incentives

The physical activity loyalty card scheme

The concept of loyalty (or reward) cards is very different from cash incentives. Cash has low “trophy value” as it tends to disappear in paying for life’s necessities. However, people tend to over-value “points” relative to their monetary value as they are seen as more personal, actual rewards (or treat), which an individual has achieved for positive behavior change. In addition, loyalty cards give the recipient a wide choice of options for redemption, so the reward possibilities abound and the recipient self-selects the most meaningful reward.

Sustainable Behavior Change

Some researchers have expressed caution about using extrinsic financial incentives as they may have the undesired effects of actually inhibiting or “crowding out” intrinsic motivation, thereby reducing the likelihood of the desired change in behavior in the long term. However, with loyalty cards, the reward levels are typically smaller, with the ability of shifting motivation from extrinsic to intrinsic by tailoring the program using the “earn and burn rate” data from the participant to lessen the emphasis on the actual reward.

Sustainable Business Model

The long-term sustainability of previous large financial incentive schemes is questionable. If such interventions are to be implemented on a large scale, it is imperative that they are based on a sustainable business model. The ready buy-in of the retail partners in our studysuggests that a sustainable model could be achievable. Such schemes could provide a win–win for both public health and businesses by offering modest financial incentives such as retail vouchers, in return for increased numbers of customers (or footfall) for local retailers.

In summary, the concept of loyalty cards provides new thinking in developing interventions that encourage sustainable behavior change in public health. There is much to learn in terms of how best it can be applied; however, it offers much potential.

— Ruth Hunter, PhD
Centre for Public Health/UKCRC Centre of Excellence for Public Health (NI)
Queen’s University Belfast

News from AJPM

New Editorial Team at AJPM
AJPM’s Editorial Offices are now located at the University of Michigan School of Public Health. Meet the new editorial team here. Please note that all correspondence to AJPM should be sent to ajpm@umich.edu.

Updated Author Instructions and Editorial Policies Released
AJPM has released new formatting guidelines and reporting requirements for authors preparing to submit manuscripts. Please see our new manual for authors. All manuscripts submitted starting January 1, 2014 will be required to follow the new submission guidelines.